Provider Demographics
NPI:1982601357
Name:DUNHAM, THOMAS STEPHEN (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:STEPHEN
Last Name:DUNHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:MCVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58254-0365
Mailing Address - Country:US
Mailing Address - Phone:701-322-5111
Mailing Address - Fax:701-322-5111
Practice Address - Street 1:1820 S 42ND ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5712
Practice Address - Country:US
Practice Address - Phone:701-775-3151
Practice Address - Fax:701-775-3153
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
870421 G2OtherVSI
ND60300Medicaid
ND00568Medicaid
ND00568Medicaid
NDN8924Medicare PIN
0161450002Medicare NSC
NDT66865Medicare UPIN
N8811Medicare PIN
870421 G2OtherVSI